Provider Demographics
NPI:1952632192
Name:PEMBROKE DENTAL PLLC
Entity Type:Organization
Organization Name:PEMBROKE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-961-5858
Mailing Address - Street 1:6415 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2137
Mailing Address - Country:US
Mailing Address - Phone:954-961-5858
Mailing Address - Fax:954-961-6267
Practice Address - Street 1:6905 W BROWARD BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2903
Practice Address - Country:US
Practice Address - Phone:954-641-0414
Practice Address - Fax:954-641-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN171501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty